Ask the Pharmacist 8 Types of Drugs That Can Cause Leg Cramps

Ask the Pharmacist

8 Types of Drugs That Can Cause Leg Cramps

Pain may be a sign of an underlying medical problem

by Dr. Armon B. Neel Jr., AARP, January 10, 2013 En Espa?ol l The older you are, the more likely you are to get nighttime leg cramps -- sudden jolts of pain that can last from just a few seconds to 15 or more minutes. Some studies, in fact, suggest that more than two-thirds of older people have experienced these painful cramps. Subscribe to the AARP Health Newsletter

Are you having painful leg cramps? You may want to change your prescription meds. -- Norbert Schaefer/Corbis Nighttime leg cramps typically affect the calf muscles, but you can also get them in the feet or thighs. They may be caused by sitting -- or standing on hard surfaces -- for too long; wearing uncomfortable shoes or shoes with elevated heels; dehydration (which can deplete electrolytes that are key to proper muscle function); some medical conditions, such as diabetes or edema; and, finally, certain medications.

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Here are the eight types of drugs that most frequently cause nighttime leg cramps. If you're taking any of them and experiencing cramps, you should consult with your doctor or other health care professional about the possibility of adjusting the dosage or changing to another type of medication or treatment.

And even if you aren't taking one of these drugs, it's still wise to consult with your doctor if you often cramp up at night. In most cases, leg cramps are harmless. But they can signal an underlying medical problem, especially if you also have muscle weakness, swelling, or numbness or pain that just won't go away.

1. Short-acting loop diuretics

Why they're prescribed: Diuretics (also called water pills) are used to treat high blood pressure, congestive heart failure and edema, among other conditions. Diuretics help the body get rid of excess fluid by moving it into the urine.

Short-acting loop diuretics, so named because they are rapidly eliminated from the body, include bumetanide (Bumex) and furosemide (Lasix, Puresis).

How they can cause leg cramps: Diuretics increase the body's excretion of some electrolytes -- including sodium, chloride and potassium -- through the urine. Low levels of these can cause extreme fatigue and muscle weakness, as well as achy joints, bones and muscles.

Alternatives: A low dose of a long-acting loop diuretic, such as torsemide (Demadex), can reduce the risk of electrolyte loss. It may also be helpful to cut back on dietary salt, exercise more and control your fluid intake. Be careful with salt substitutes, however, as most contain potassium chloride and can also cause electrolyte imbalances. And be sure to consult a health care professional before beginning a new exercise regimen.

2. Thiazide diuretics

Why they're prescribed: Thiazide diuretics are most commonly used to treat high blood pressure, although they are also used to treat congestive heart failure, edema and other conditions.

Examples of thiazide diuretics include chlorothiazide (Diuril), hydrochlorothiazide (Microzide), indapamide (Lozol) and metolazone (Zaroxolyn).

How they can cause leg cramps: Like short-acting loop diuretics (see above), thiazide diuretics can deplete key electrolytes, causing leg cramps and other serious muscle problems.

Alternatives: Talk with your health care provider about the advisability of switching to a low dose of a long-acting loop diuretic, such as torsemide (Demadex), which can significantly reduce the risk of electrolyte loss, or to another hypertension medication. It may also be helpful to cut back on dietary salt, exercise more and control your fluid intake. Be careful with salt substitutes, however; most contain potassium chloride and can also cause electrolyte imbalances. And consult a health care professional before beginning a new exercise regimen.

Next page: Beta-blockers. ?

3. Beta-blockers

Why they're prescribed: Beta-blockers are typically prescribed to treat high blood pressure (hypertension) and arrhythmias (abnormal heart rhythms). These drugs slow the heart rate and lower blood pressure by blocking the effect of the hormone adrenaline. Beta-blockers are also used to treat angina, migraines, tremors and, in eyedrop form, certain kinds of glaucoma.

Examples: atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), propranolol (Inderal), sotalol (Betapace), timolol (Timoptic) and some other drugs whose chemical names end with "-olol."

How they can cause leg cramps: Researchers have known for more than 20 years that beta-blockers can induce leg cramps, but they haven't yet determined why. Studies have shown that beta-blockers cause the arteries in the legs and arms to narrow, which in turn causes less blood to flow through the limbs. That's why some people who take beta-blockers have cold hands and feet, a condition known as peripheral vasoconstriction. (Should you experience this side effect, it's important to let your physician know as soon as possible.) Because there's often a delay between starting on a betablocker and the appearance of leg cramps -- anywhere from a few months to more than two years) -- patients typically don't suspect a connection between the two.

Alternatives: For older people, benzothiazepine calcium channel blockers, another type of blood pressure medication, are often safer and more effective than beta-blockers.

4. Statins and fibrates

Why they're prescribed: Statins and fibrates are used to treat high cholesterol. The top-selling statins are atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor); the topselling fibrate is fenofibrate (Tricor).

How they can cause leg cramps: Studies show that statins can inhibit the production of satellite cells in the muscle, interfering with muscle growth. Some researchers have also suggested that statins work, at the cellular level, to sap energy. Muscle weakness and aches throughout the body can be symptoms of statin-induced rhabdomyolysis, a breakdown of skeletal muscle that causes muscle fibers to be released into the bloodstream, sometimes harming the kidneys. Additionally, older adults who take these drugs are at greater risk of developing sarcopenia, or the wasting away of skeletal muscle and strength that's associated with aging.

Alternatives: If you're among the many millions of older Americans who don't have known heart disease but are taking these drugs to lower their slightly elevated cholesterol, ask your doctor or other health care provider about trying to lower your cholesterol by changing your diet. You also might try lowering your blood levels of homocysteine -- which is linked to high cholesterol -- by taking a combination of sublingual (under-thetongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily) and vitamin B6 (200 mg daily).

Next page: Beta2-agonists. ?

5. Beta2-agonists

Why they're prescribed: Beta2-agonists are bronchodilators -- drugs that relax the smooth muscles surrounding the bronchial tubes, making it easier to breathe. They're frequently

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